Dear Colleague

Many thanks for your interest in the Wild-Ness Lifestyle Medicine Retreats next month at Bearnock Lodge. We will reply via email within 24hrs of receiving this form, to confirm room availability and provide payment details. I look forward to meeting you then.

Best wishes
Kath Jones
Wild-Ness Retreats

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* 1. Which retreat you would you like to book for

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* 2. Please state your full name

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* 3. Please state your preferred email contact

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* 4. Please state your preferred phone contact

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* 5. Please describe your gender

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* 6. What is your current clinical or therapeutic role?

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* 7. Please state your preferred room at Bearnock Lodge

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* 8. Please specify the name and email contact of the person you plan to share a room with

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* 9. Do you have any questions that you would like to ask about the retreat at this stage?

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